<html lang="en">
  <head>
    <meta charset="utf-8">
    <title>Flat UI Free</title>
    <meta name="viewport" content="width=device-width, initial-scale=1.0">

    <!-- Loading Bootstrap -->
    <link href="../../plugins/Flat-UI-master/bootstrap/css/bootstrap.css" rel="stylesheet">

    <!-- Loading Flat UI -->
    <link href="../../plugins/Flat-UI-master/css/flat-ui.css" rel="stylesheet">
	
	<!-- Loading Custom Theme -->
	<link href="../../css/custom-theme.css" rel="stylesheet">
	
    <!-- HTML5 shim, for IE6-8 support of HTML5 elements. All other JS at the end of file. -->
    <!--[if lt IE 9]>
      <script src="js/html5shiv.js"></script>
      <script src="js/respond.min.js"></script>
    <![endif]-->
  </head>
  <body onbeforeunload="resetsearch()" class="default">
	<nav class="navbar navbar-inverse navbar-fixed-top" role="navigation">
		<div class="container">
			<div class="row">
				<div class="collapse navbar-collapse" id="navbar-collapse-01">
					<ul class="nav navbar-nav">
						<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/index" target="_top">HOME</a></li>
						<li class="dropdown">
							<a href="#" class="dropdown-toggle" data-toggle="dropdown">HEALTH CARE INDUSTRY</a>
							<ul class="dropdown-menu">
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-overview" target="_top">Overview</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-challenges" target="_top">Challenges</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-health-care-professionals" target="_top">Health Care Professionals</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-financing-and-economics" target="_top">Financing and Economics</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-key-measures" target="_top">Key Measures</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/health-care-industry-regulations-and-standards" target="_top">Regulations and Standards</a></li>
							</ul>
						</li>
						<li class="dropdown active">
							<a href="#" class="dropdown-toggle" data-toggle="dropdown">INDUSTRY SEGMENTS</a>
							<ul class="dropdown-menu">
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-revenue-cycle-management" target="_top">Revenue Cycle Management</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-hospital-and-hospital-systems" target="_top">Hospital & Hospital Systems</a></li>
								<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-managed-care" target="_top">Managed Care</a></li>							
							</ul>
						</li>
						<li><a href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-trends-and-updates" target="_top">INDUSTRY TRENDS & UPDATES</a></li>
					</ul>
					<form action="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/system/app/pages/search" target="_top" class="navbar-form navbar-right" id="search" role="search">
						<div class="form-group">
							<div class="input-group">
								<input class="form-control" type="search" placeholder="Search" id="navbarInput-01" name="q">
								<span class="input-group-btn">
									<button type="submit" class="btn"><span class="fui-search"></span></button>
								</span>            
							</div>
						</div>               
					</form>
				</div>
			</div>
		</div>
	</nav>
	
	<div class="container">
		<div class="row">
			<div class="col-sm-2 block2 colorBar">
				<a class="leftArrow" href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-revenue-cycle-management/overview" target="_top">
					<span class="glyphicon glyphicon-chevron-left"></span>
				</a>
			</div>
			<div class="col-sm-8">
				<div class="closecontainer">
					<a class="closebutton col-scale" href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-revenue-cycle-management" target="_top">
						<span class="glyphicon glyphicon-remove" style="color:#afafaf; size: 14px; text-align: center; left:9px; top: 9px;"></span>
					</a>
				</div>
				<div class="row">
					<p class="content-title">THE REVENUE CYCLE</p>
				</div>
				<div class="row">
					<img src="../../img/industry-segments-revenue-cycle-management/Proposed Revenue Cycle Model.png" width="645px" height="500px" style="position: absolute; z-index: -1;"></img>
				</div>
				<div class="row">
					<div class="row">
						<div class="col-sm-4"></div>
						<div class="col-sm-2 paragraph">
							<!-- <a id="pop" class="paragraph" style="display: hidden;" 
								href="#" 
								data-toggle="popover" 
								data-trigger= "hover" 
								data-placement="right" 
								data-animation="true"
								data-html="true"
								data-container="body" 
								title="Performance Measurements"
								data-content="Collect data to measure revenue cycle performance and develop financial strategies">A
								</a> -->
							<div class="hoverText block1">								
								<p class="hoverTitle">Performance Measurements</p>
								<p class="hoverContent">Collect data to measure revenue cycle performance and develop financial strategies</p>
							</div>
						</div>
						<div class="col-sm-3">
							<div class="hoverText block8">
								<p class="hoverTitle">Appointment Scheduling</p>
								<p class="hoverContent">Schedule inpatient admission, outpatient tests, clinic visits</p>
							</div>
						</div>
						<div class="col-sm-3"></div>
					</div>
					<div class="row">
						<div class="col-sm-2"></div>
						<div class="col-sm-2">
							<div class="hoverText block1">
								<p class="hoverTitle">Collections and Payment Posting</p>
								<p class="hoverContent">Review the Explanation of Benefits (EOB) or </p>
								<p class="hoverContent">Electronic Remittance Advice (ERA)</p>
								<p class="hoverContent">Produce patient statements</p>
								<p class="hoverContent">Handle patient inquiries</p>
								<p class="hoverContent">Issue refunds</p>
								<p class="hoverContent">Handle patient inquiries</p>
								<p class="hoverContent">Post all payments and adjustments</p>
								<p class="hoverContent">Write off bad debt</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2">
							<div class="hoverText block8">
								<p class="hoverTitle">Pre-registration and Pre-admission</p>
								<p class="hoverContent">Collect the financial and demographic information from the patient</p>
							</div>
						</div>	
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-2">
							<div class="hoverText block1">
								<p class="hoverTitle">Denial Management and Appeals</p>
								<p class="hoverContent">Analyze reasons for denials</p>
								<p class="hoverContent">Resubmit claims</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>					
						<div class="col-sm-2">
							<div class="hoverText block8">
								<p class="hoverTitle">Benefits Confirmation and Authorization</p>
								<p class="hoverContent">Check insurance eligibility</p>
								<p class="hoverContent">Get payor authorization and referral</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-2">
							<div class="hoverText block1">
								<p class="hoverTitle">Accounts Follow-up</p>
								<p class="hoverContent">Monitor the lag time from claim submission to payment</p>
								<p class="hoverContent">Follow up with insurance carriers regarding pending claims</p>
								<p class="hoverContent">Send an acknowledgement when the claim is paid, pended, or denied</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>			
						<div class="col-sm-2">
							<div class="hoverText block8">
								<p class="hoverTitle">Financial Counselling</p>
								<p class="hoverContent">Discuss payment arrangements</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-2">
							<div class="hoverText block1">
								<p class="hoverTitle">Claims Preparation and Submission</p>
								<p class="hoverContent">Prepare clean claims</p>
								<p class="hoverContent">Submit claims electronically or manually</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>			
						<div class="col-sm-2">				
							<div class="hoverText block8">
								<p class="hoverTitle">Registration and Check-in</p>
								<p class="hoverContent">Obtain copies of all insurance cards</p>
								<p class="hoverContent">Request for a valid photo ID</p>
								<p class="hoverContent">Collect patient's co-payment, co-insurance, deductible</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-2">
							<div class="hoverText block13">
								<p class="hoverTitle">Charge Capture</p>
								<p class="hoverContent">Identify activities and charges for an encounter</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2">
							<div class="hoverText block7">
								<p class="hoverTitle">Clinical Encounter</p>
								<p class="hoverContent">Collect patient history, perform physical examination,
									establish diagnosis, and/or provide treatment as needed</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-2"></div>
						<div class="col-sm-2">
							<div class="hoverText block13">
								<p class="hoverTitle">Inpatient and Outpatient Coding</p>
								<p class="hoverContent">Assign appropriate diagnosis, procedure, and supply codes to the patient record.</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2"></div>
						<div class="col-sm-2">
							<div class="hoverText block7">
								<p class="hoverTitle">Medical Records Documentation</p>
								<p class="hoverContent">Document the details of patient and family history, extent of physical exam, complexity of medical decision making,
									nature of patient’s problems, minutes of service, and any counselling</p>
							</div>
						</div>
						<div class="col-sm-2"></div>
					</div>
					<div class="row">
						<div class="col-sm-4"></div>
						<div class="col-sm-4">
							<div class="hoverText block7">
							<p class="hoverTitle">Discharge</p>
							<p class="hoverContent">Complete appropriate discharge documentation</p>
							<p class="hoverContent">Patient signs all required consents/forms</p>
							<p class="hoverContent">Patient leaves the facility and either returns home or is transferred to another facility</p>
						</div>
						</div>					
						<div class="col-sm-4"></div>
					</div>
				</div>
				<p class="content-subtitle">Data Quality</p>
				<ul class="paragraph">
					<li>Every phase of the revenue cycle depends on the completeness and accuracy of the data collected.</li>
					<li>An error in one step affects the whole cycle and ultimately affects reimbursement for the health care organization.</li>
				</ul>
				<p class="content-subtitle">Patient Access</p>
				<p class="content-subtitle text-underline">Appointment Scheduling</p>
				<ul class="paragraph">
					<li>For elective inpatient visits, schedule the admission. For outpatient and clinic visits, schedule the visit.</li>
					<li>Schedules should be updated regularly for cancellations, no-shows, or rescheduled appointments.</li>
				</ul>
				<p class="content-subtitle text-underline">Pre-registration and Pre-admission</p>
				<ul class="paragraph">
					<li>Collect the financial and demographic information of the guarantor and the patient.</li>
				</ul>
				<p class="content-subtitle text-underline">Benefits Confirmation and Authorization</p>
				<ul class="paragraph">
					<li>Check the patient’s eligibility and create the insurance verification (policy limits, deductibles, etc.) for the patient accounting system.</li>
					<li>In certain circumstances a referral, authorization, or notification are required prior to care. Failure to obtain the necessary permissions 
						will result in the denial of your claim.</li>
					<li>Integrate eligibility and authorization/referral responses into the patient’s file.</li>
				</ul>
				<p class="content-subtitle text-underline">Financial Counseling</p>
				<ul class="paragraph">
					<li>If the patient has indicated an inability to meet the financial requirements, they can explore alternative arrangements. This can be done prior 
						to admission, at admission, or while the patient is in the institution.</li>
					<li>Financial counsellors can collect some funds at this point and arrange for a payment program that is agreed upon by the patient. This may result 
						in payments via any of the payment mechanisms and payment sources available to the patient.</li>
				</ul>
				<p class="content-subtitle text-underline">Registration and Check-in</p>
				<ul class="paragraph">
					<li>Obtain copies of all insurance cards (primary, secondary, and tertiary coverage).</li>
					<li>Request a form of photo ID to verify the patient’s identity.</li>
					<li>Patient responsibility payment for services can be collected at time of check-in if it was not collected at pre-admission. Typically, the patient 
						will be notified of any obligation and will present cash, check, or a credit card for payment and the payment will be processed at the time of 
						registration or admission.</li>
					<li>For inpatient stays, an estimated co-pay can be collected upfront and can be reconciled after services are rendered.</li>
					<li>Registration documents should be filed in the patient’s record. </li>
				</ul>
				<p class="content-subtitle">Case Management</p>
				<p class="content-subtitle text-underline">Clinical Encounter</p>
				<ul class="paragraph">
					<li>Clinical encounter is the direct interaction between a patient and a practitioner vested with the primary responsibility for diagnosing, evaluating, 
						and/or treating the patient’s condition.</li>
				</ul>
				<p class="content-subtitle text-underline">Medical Records Documentation</p>
				<ul class="paragraph">
					<li>The documentation of each patient encounter should be complete and consistent.</li>
					<li>The reason for—and results of—tests and other ancillary services should be included in the medical record.</li>
					<li>The patient’s progress, including response to treatment, change in treatment, change in diagnosis, and patient non-compliance, should be documented.</li>
					<li>The documentation should support the intensity of the patient evaluation and/or the treatment, including through processes and the complexity of 
						medical decision-making s it relates to the patient’s chief complaint for the encounter.</li>
				</ul>
				<p class="content-subtitle text-underline">Discharge</p>
				<ul class="paragraph">
					<li>Develop of an individualized discharge plan for the patient prior to leaving the hospital to ensure that they are discharged at an appropriate time 
						and with provision of adequate post-discharge services.</li>
					<li>All required consents/forms should be signed by the patient prior to discharge.</li>
					<li>If discharge to the outpatient setting is not appropriate, the team must then arrange transfer to another inpatient facility for ongoing care.</li>
				</ul>
				<p class="content-subtitle">Health Information Management</p>
				<p class="content-subtitle text-underline">Inpatient and Outpatient Coding</p>
				<ul class="paragraph">
					<li>Coding is a numerical expression of what, why, and how care is delivered.</li>
					<li>Procedure codes (CPT) and supply codes (HCPCS) are used to identify what the provider has done when coding encounters and procedures. Diagnosis codes 
						(ICD-9/ICD-10) describe the reason the specific CPT and HCPCS codes were performed.</li>
					<li>Because the codes selected will determine the reimbursement, coding should be considered one of the most important steps in managing the revenue cycle.</li>
				</ul>
				<p class="content-subtitle text-underline">Charge Capture</p>
				<ul class="paragraph">
					<li>Charge capture is the process of determining and reporting charges for services a provider performs.</li>
					<li>Capture both institutional and professional services, as well as items and pharmaceuticals provided for both inpatient admissions and outpatient visits.</li>
					<li>Charges captured in system by clinical departments or on charge slips/superbills/charge tickets are forwarded for entry into the patient’s record.</li>
					<li>The utilization review staff validates the stay based on the payor’s criteria for reimbursement.</li>
				</ul>
				<p class="content-subtitle">A/R Management</p>
				<p class="content-subtitle text-underline">Claims Preparation and Submission</p>
				<ul class="paragraph">
					<li>Before a claim is submitted, it is first “scrubbed” to determine if any required information is missing or incorrect.</li>
					<li>Once the claim information is completed, the business office submits a ‘clean’ claim to their clearinghouse for submission or sends the claim directly 
						to the insurance carrier.</li>
					<li>Many patients have secondary coverage. In these circumstances, the provider can submit a secondary claim for additional payment from payors.</li>
					<li>A best practice for hospitals is to submit a ‘clean’ claim for processing within three days from discharge.</li>
				</ul>
				<p class="content-subtitle text-underline">Denial Management and Appeals</p>
				<ul class="paragraph">
					<li>The biller identifies and resolves denied, rejected, or pending claims with the payor.</li>
					<li>There are three different types of denials: clinical denials, underpayment, and technical denials.</li>
					<li>The biller may request the payor to reconsider denial, rejection, and additional payments.</li>
					<li>The most common reasons that a claim submission is rejected or returned are: duplicate claims, incomplete information, expired eligibility, 
						service not covered, and claim submission time limit expired.</li>
					<li>Based on the denial reason, you may need to provide the carrier with corrected or additional information.</li>
					<li>Institutions that can keep their denial rates at 3% or less are considered well run.</li>
				</ul>
				<p class="content-subtitle text-underline">Accounts Follow-up</p>
				<ul class="paragraph">
					<li>Closely monitoring lag time from claim submission to payment can help accounts receivable identify average durations of payment and when action is necessary.</li>
					<li>Per HIPAA regulations, Third Party Payors must pay or deny a claim within 30 days of receipt.</li>
					<li>Some payors send an unsolicited response or a response to a claim status inquiry. Typically, a comment is posted to the system recording the reason for it being paid, 
						pended, or denied.</li>
					<li>The most common reasons that a claim submission is rejected or returned are: duplicate claims, incomplete information, expired eligibility, 
						service not covered, and claim submission time limit expired.</li>
					<li>Based on the denial reason, you may need to provide the carrier with corrected or additional information.</li>
					<li>Institutions that can keep their denial rates at 3% or less are considered well run.</li>
				</ul>	
				<p class="content-subtitle text-underline">Collections and Payment Posting</p>
				<ul class="paragraph">
					<li>The Explanation of Benefits (EOB) received from the insurance/third-party carriers is reviewed for payment details, and if any contractual write off’s – 
						the difference between the facility charge and the payment received will be taken. Determination of whether appropriate reimbursement has been made, and if not, 
						an appeal, a formal request for reconsideration is made.</li>
					<li>If the provider has not been able to collect the deductible, co-insurance, or co-payment or if there are additional patient payment obligations due, 
						the provider must send out a patient statement. Failure to respond to an initial patient statement may result in the mailing of additional “third-party 
						letters” to encourage payment.</li>
					<li>Before writing off an account to bad debt, institutions will give collection agencies an opportunity to work the accounts to see if they can collect the 
						money from the patient.</li>
					<li>In order to promptly and accurately post payments, mail must be opened upon receipt and deposits made daily. A third party such as a bank “Lock Box” 
						should be used to ensure proper cash handling procedures.</li>
					<li>When payments are received, the appropriate payments and insurance carriers are posted to the patient accounts along with any patient payments until 
						the balance has been satisfied.</li>
				</ul>
				<p class="content-subtitle text-underline">Performance Measurements</p>
				<ul class="paragraph">
					<li>Health care providers must have tangible, real-time data to measure performance both for internal management purposes and for external measurement 
						in relation to peers, competitors, and the community.</li>
					<li>Measuring department- and task-level performance, productivity, patient satisfaction, and customer demand for services is critical to an organization’s 
						revenue cycle performance improvement strategy.</li>
					<li>The financial health of a practice can be measured with several key metrics such as collection percentage, days in A/R, and A/R turn ratio.</li>
					<li>Additional metrics to help monitor your practice are total visits, average visits per day, charges and receipts per visit, and the average lag time 
						from the time services are rendered (date of service) and the time claims are submitted (date of entry).</li>
				</ul>
			</div>
			<div class="col-sm-2 block2 colorBar">
				<a class="rightArrow" href="https://sites.google.com/a/pointwest.com.ph/hmc-domain-website/industry-segments-revenue-cycle-management/sample-rcm-process" target="_top">
					<span class="glyphicon glyphicon-chevron-right"></span>
				</a>
			</div>
		</div>
	</div>

    <!-- Load JS here for greater good =============================-->
    <script src="../../flat-ui/js/jquery-1.8.3.min.js"></script>
    <script src="../../flat-ui/js/jquery-ui-1.10.3.custom.min.js"></script>
    <script src="../../flat-ui/js/jquery.ui.touch-punch.min.js"></script>
    <script src="../../flat-ui/js/bootstrap.min.js"></script>
    <script src="../../flat-ui/js/bootstrap-select.js"></script>
    <script src="../../flat-ui/js/bootstrap-switch.js"></script>
    <script src="../../flat-ui/js/flatui-checkbox.js"></script>
    <script src="../../flat-ui/js/flatui-radio.js"></script>
    <script src="../../flat-ui/js/jquery.tagsinput.js"></script>
    <script src="../../flat-ui/js/jquery.placeholder.js"></script>
	<script src="../../js/custom-theme.js"></script>
	<script>
	$(function () 
      { $("[data-toggle=popover]").popover();
      });
	</script>
  </body>
</html>